August 14, 2016

Bariatric surgery is associated with improvement in kidney outcomes

Chang AR, Chen Y, Still C, Wood GC, Kirchner HL, Lewis M, Kramer H, Hartle JE, Carey D, Appel LJ, Grams ME.   Kidney Int.   2016 Jul;90(1):164-71

In this matched cohort study, 985 patients who underwent bariatric surgery were compared 985 patients that did not.  The mean 1-year weight loss was 40.4 kg in the surgery group compared with 1.4 kg in the matched cohort. In adjusted analyses, bariatric surgery patients had a 58% lower risk for an eGFR decline of ≥30% (hazard ratio 0.42, 95% confidence interval 0.32-0.55) […]

Leave a Comment! Posted in Chronic Kidney Disease, General Nephrology
August 14, 2016

Past Decline Versus Current eGFR and Subsequent ESRD Risk

Kovesdy CP, Coresh J, Ballew SH, Woodward M, Levin A, Naimark DM, Nally J, Rothenbacher D, Stengel B, Iseki K, Matsushita K, Levey AS, CKD Prognosis Consortium.   J Am Soc Nephrol.   2016 Aug;27(8):2447-55

This CKD Prognosis Consortium study examined 22 cohorts to determine the association of past slopes and current eGFR level with subsequent ESRD.  5163 ESRD events were recorded in the 1,080,223 participants during a mean follow-up of 2.0 years. The results showed that current eGFR [30 versus 50 ml/min per 1.73 m(2) (a difference of 20 ml/min per 1.73 m(2)) associated with an adjusted hazard ratio […]

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Nephrology, General Nephrology
August 14, 2016

Past Decline Versus Current eGFR and Subsequent Mortality Risk

Naimark DM, Grams ME, Matsushita K, Black C, Drion I, Fox CS, Inker LA, Ishani A, Jee SH, Kitamura A, Lea JP, Nally J, Peralta CA, Rothenbacher D, Ryu S, Tonelli M, Yatsuya H, Coresh J, Gansevoort RT, Warnock DG, Woodward M, de Jong PE, CKD Prognosis Consortium.   J Am Soc Nephrol.   2016 Aug;27(8):2456-66

This is an individual-level meta-analysis of the risk of mortality associated with antecedent eGFR slope among 1.2 million subjects within the CKD Prognosis Consortium. Over a 3-year antecedent period, compared with a slope of 0 ml/min per 1.73 m(2) per year, a slope of -6 ml/min per 1.73 m(2) per year was associated with adjusted hazard ratios for all-cause mortality of […]

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Nephrology, Clinical Trial Results
August 14, 2016

Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75Years: A Randomized Clinical Trial

Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, Fine LJ, Haley WE, Hawfield AT, Ix JH, Kitzman DW, Kostis JB, Krousel-Wood MA, Launer LJ, Oparil S, Rodriguez CJ, Roumie CL, Shorr RI, Sink KM, Wadley VG, Whelton PK, Whittle J, Woolard NF, Wright JT Jr, Pajewski NM, SPRINT Research Group.   JAMA.   2016 Jun 28;315(24):2673-82

This is a  multicenter, randomized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT) to determine the effects of intensive (<120 mm Hg) compared with standard (<140 mm Hg) SBP targets. The primary cardiovascular disease outcome was a composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes. All-cause mortality […]

Leave a Comment! Posted in Clinical Trial Results, Hypertension
August 14, 2016

Renal Complications of Hematopoietic-Cell Transplantation

Hingorani S.   N Engl J Med.   2016 Jun 9;374(23):2256-67

This is a nice review of the topic.

Leave a Comment! Posted in Clinical Nephrology, Review
August 14, 2016

Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit

Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Bretagnol A, Mayaux J, Nseir S, Megarbane B, Thirion M, Forel JM, Maizel J, Yonis H, Markowicz P, Thiery G, Tubach F, Ricard JD, Dreyfuss D, AKIKI Study Group.   N Engl J Med.   2016 Jul 14;375(2):122-33

   This multicenter randomized trial assigned 620 ICU patients with severe stages 1-3 AKI with either an early dialysis start (at randomization) or late dialysis start (a classic indication to initiate).  The primary outcome was survival at day 60.  There was no survival difference between the groups at day 60; 150 deaths occurred among 311 […]

Leave a Comment! Posted in Acute Kidney Injury, Clinical Nephrology, Clinical Trial Results
August 14, 2016

Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes

Wanner C, Inzucchi SE, Lachin JM, Fitchett D, von Eynatten M, Mattheus M, Johansen OE, Woerle HJ, Broedl UC, Zinman B, EMPA-REG OUTCOME Investigators.   N Engl J Med.   2016 Jul 28;375(4):323-34

  This randomized control trial of over 4000 high risk patients with Type 2 diabetes and eGFR > 30 ml/min, empagliflozin (a sodium-glucose cotransporter 2 inhibitor) when compared with placebo was associated with slower progression of kidney disease (12.7% vs 18.8% for worsening nephropathy and 1.5% vs 2.6% for doubling of serum creatinine) when added to the standard of care.  […]

Leave a Comment! Posted in Chronic Kidney Disease, Clinical Nephrology, Clinical Trial Results, Diabetes, General Nephrology
August 14, 2016

Lupus nephritis management guidelines compared

Wilhelmus S, Bajema IM, Bertsias GK, Boumpas DT, Gordon C, Lightstone L, Tesar V, Jayne DR.   Nephrol Dial Transplant.   2016 Jun;31(6):904-13

This review summarizes the 6 difference guidelines for treatment lupus nephritis – the commonalities, differences as well as highlights the recent literature.    

Leave a Comment! Posted in Clinical Nephrology, Clinical Practice Guidelines, Glomerulonephritis, Lupus
August 14, 2016

Management of the Hemodialysis Unit: Core Curriculum 2016

Blankschaen SM, Saha S, Wish JB.   Am J Kidney Dis.   2016 Aug;68(2):316-27

This interesting core curriculum article summarizes all the facets involving in running and maintaining a hemodialysis unit.  It is valuable information for both trainees and practicing nephrologists.

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May 29, 2016

Pregnancy across the spectrum of chronic kidney disease

Hladunewich MA, Melamad N, Bramham K.   Kidney Int.   2016 May;89(5):995-1007

  This paper highlights some of the available data as well as management strategies for nephrologists managing pregnant patients with chronic kidney disease.    

Leave a Comment! Posted in Clinical Nephrology, Pregnancy and Hypertension/Renal Disease
May 29, 2016

Communication Skills and Decision Making for Elderly Patients With Advanced Kidney Disease: A Guide for Nephrologists

Koncicki HM, Schell JO.   Am J Kidney Dis.   2016 Apr;67(4):688-95

As we all know, elderly patients comprise the most rapidly growing population initiating dialysis therapy. This review provides nephrologists with the palliative skills that can help care for this patients and aid in dialysis treatment decisions as well as decisions regarding overall goals of care.  

Leave a Comment! Posted in Clinical Nephrology
May 29, 2016

Autosomal Dominant Polycystic Kidney Disease: Core Curriculum 2016

Chebib FT, Torres VE.   Am J Kidney Dis.   2016 May;67(5):792-810

  This core curriculum is a comprehensive overview on ADPKD that should prove to be valuable to both trainee and consultant physicians.

Leave a Comment! Posted in AJKD Core Curriculum, Clinical Nephrology, Polycystic Kidney Disease